The prediction of adverse outcomes in patients with pulmonary embolism

Pronin A. G., Sivokhina N. Yu., Rakhmatullina A. R., Glukhov D. K.

ABSTRACT

Objective. To establish the prognostic criteria of mortality and chronic thromboembolic pulmonary hypertension (CTEPH) in patients with pulmonary embolism (PE).

Materials and methods. The study included 155 patients with PE. During the study follow up, 42 patients deceased, 50 patients developed CTEPH 6 months after PE, 63— complete recanalization of the pulmonary arteries. The course of the disease in these patients was analyzed in order to establish the most significant criteria for adverse outcomes.

Results. The symptoms of pulmonary embolism associated with mortality included: cardiac stroke volume reduction according to echocardiography (Echo-CG), the right ventricular to left ventricular diameter ratio over 0.9, blood pressure decrease less than 90/60 mm Hg, a history of syncope, paradoxical interventricular septal motion according to Echo-KG, jugular venous ectasia, SIQIII pattern in the electrocardiogram, over 75% of thrombotic occlusion of the pulmonary artery according to computed angiopulmonography, concomitant anemia, elevated plasma concentrations of troponin level. The probability of CTEPH increased in patients with PE accompanied by: recurrent course of the disease, T-wave inversions in V1 to V3 leads in the electrocardiogram, late therapy initiation, over 60% pulmonary arterial occlusion, the right ventricular to left ventricular diameter ratio over 0.9, over 30 mm Hg pressure elevation in pulmonary artery.

Conclusion. Active methods of treatment can be recommended in patients who meet the criteria associated with mortality, including systemic thrombolysis and open or endovascular thrombectomy. Patients with high probability of CTEPH development may require dynamic monitoring followed by the treatment alteration when necessary: anticoagulant therapy correction or the performance of balloon pulmonary angioplasty.

Keywords: pulmonary embolism, adverse disease outcome, chronic thromboembolic pulmonary hypertension, mortality.

For citation:

Pronin A. G., Sivokhina N. Yu., Rakhmatullina A. R., Glukhov D. K. The prediction of adverse outcomes in patients with pulmonary embolism. International Heart and Vascular Disease Journal. 2022. 10 (34): 11-17. DOI 10.24412/2311-1623-2022-34-14-22